What are the responsibilities and job description for the CREDENTIALING MANAGER position at SOFHA EMPLOYMENT SERVICES INC?
WHO WE ARE:
State of Franklin Healthcare Associates is a physician-led and team-member owned multi-specialty care group of more than 250 providers and 900 team members headquartered in Johnson City, TN with 35 locations in the upper East Tennessee & Southwest Virginia region. Our mission is to improve the health and well-being of our patients and our team members.
PRIMARY RESPONSIBILITIES:
- Provides supervision of credentialing staff.
-
Credentials new providers and re-credentials existing providers to include completing the applications for:
- Hospital and facility privileges
- DEA and medical license address corrections
- SVMIC malpractice insurance
- Council for Affordable Quality Health Care (CAQH) - houses all providers information
- NPI databank
- Disclosure of Ownership
- Participation in Medicare; and
- Participation in State of Franklin Healthcares payer agreements.
- The Credentialing Manager oversees the operation of the Credentialing department to develop, manage, and monitor processes and procedures that support the credentialing and re-credentialing process.
- Oversees all the credentialing functions including database management and primary source verification.
- Assures that credentialing database entry is accurate and consistent resulting in accuracy of information related to reports.
- Ensures compliance with appropriate accrediting and regulatory standards.
- Manages all aspects of the credentials verification process within their designated team.
- Responsible for ensuring staff are following all established processes to ensure .comprehensive and accurate completion of job duties.
- Supervises credentialing staff in the day-to day management.
- Performs credentialing audits as applicable to ensure accuracy and efficiency .
- Functions as primary contact for all internal and external contacts; develops and maintains positive working relationships.
- Responsible for assigned team members and makes recommendations to Director of Payer Relations on adequate, qualified staffing needs and workflows.
- Recommends new policies and procedures as applicable.
- May be required to perform other duties as assigned.
REQUIREMENTS:
- High school diploma or GED
EXPERIENCE:
Two years of clerical experience with demonstrated initiative and self-direction or additional related education may be substituted for the two years of clerical experience.
WHAT WE OFFER:
State of Franklin Healthcare provides a comprehensive and competitive total compensation package designed to meet the needs of our full-time team members to include:
- Company Provided Life and Accidental Death and Dismemberment Insurance
- Company Provided Long Term Disability Insurance
- Employee Stock Ownership Plan
- 401(k) Company Contributions
- Voluntary options for Medical, Dental, Vision, and additional Life Insurance.
- Company match in Health Savings Account Plans (restrictions apply)
- Vacation, Personal, Sick and Holiday Time Off
- An array of team member perks and discounts
- Tuition Assistance Programs
- And more!
